My son has broken his arm. He has a greenstick break approx. 2" below the shoulder joint on the humerus bone really close to a growth plate. The ER Dr. refered him to an Orthopaedic Dr. who put him in a sling, He said "the break was to close to the shoulder joint to put in a cast. The x-ray shows a gap on the rib side of the bone and splintering on the outside of the bone.

My question is should the bone be reset, and then casted, or has the doctor prescibed the best possible remedy

You do not say how old your son is? But, in general, proximal humerus fractures, especially those that are periphyseal, do not need surgery or very much reduction for that matter. And the younger the patient, the more displacement and angulation can be accepted. The following are the usual requirements for closed treatment of proximal humerus fractures in children.

Non Operative Treatment:

--> young children: (less than 5 years of age);
- up to 70 deg of frx angulation and minimal apposition is acceptable;
- use shoulder immobilizer, if reduction is acceptable;
- w/ displaced frxs, reduction is attempted by traction & gentle manipulation;

--> children from 5 to 12 years:
- up to 45 deg of fracture angulation and 50% apposition is acceptable;
- displaced frx will tend to redisplace if arm is placed in a shoulder immobilizer, a cast or co-apt splint is preferred;
- frx can be immobilized w/ arm at side or in slight abduction;

--> teenager:
- up to 25 deg fracture angulation and 30% apposition is acceptable;
- closed reduction may be required for significantly displaced or angulated fractures in teenagers near the end of growth (older adolescents);
- co-apt splint is usually best tolerated.

In any fracture that is unstable, or the acceptable reduction cannot be achieved or held, then closed reduction by be necessary, and if still unstable, percutaneous pinning may be necessary.

However, due to the remodeling potential of children and the mobility of the shoulder, rarely is it necessary to do more than the minimal in the treatment of children's humerus fractures. Just enough to make the child comfortable.

But, if you are concerned, you should obtain a second opinion. Good luck.